Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

GLIMP Investigators

doi:10.1016/j.chest.2020.06.079

Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

GLIMP Investigators

Institute of Medical Microbiology

52 Citations (Scopus)

Abstract

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P <.001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

Original language	English
Journal	Chest
Volume	159
Issue number	1
Pages (from-to)	58-72
Number of pages	15
ISSN	0012-3692
DOIs	https://doi.org/10.1016/j.chest.2020.06.079
Publication status	Published - 01.2021

Funding

FUNDING/SUPPORT: J. M.-C. received a mobility grant from Instituto de Salud Carlos III , Spain (M-BAE 2019). N. S. receives funding from the U.S. Department of Veterans Affairs , Quality Enhancement Research Initiative (QUERI) Partnered Evaluation Initiative Grant (HX002263-01A1). This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System in San Antonio, TX. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. FUNDING/SUPPORT: J. M.-C. received a mobility grant from Instituto de Salud Carlos III, Spain (M-BAE 2019). N. S. receives funding from the U.S. Department of Veterans Affairs, Quality Enhancement Research Initiative (QUERI) Partnered Evaluation Initiative Grant (HX002263-01A1). This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System in San Antonio, TX. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Academic Focus: Center for Infection and Inflammation Research (ZIEL)

DFG Research Classification Scheme

2.21-03 Medical Microbiology and Mycology, Hygiene, Molecular Infection Biology

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10.1016/j.chest.2020.06.079

Cite this

@article{35733233053042fc8808773f9fc1e0df,

title = "Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia",

abstract = "Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4\%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8\%) had CAP/AspRF+ and 704 (29.2\%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0\% vs 1.03\% vs 1.64\%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3\% vs 44.3\% vs 33.3\%, P =.021) and lower rates of total gram-positive bacteria (7.1\% vs 38.1\% vs 50.0\%, P <.001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50\% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.",

author = "\{GLIMP Investigators\} and Judith Marin-Corral and Sergi Pascual-Guardia and Francesco Amati and Stefano Aliberti and Masclans, \{Joan R.\} and Nilam Soni and Alejandro Rodriguez and Oriol Sibila and Francisco Sanz and Giovanni Sotgiu and Antonio Anzueto and Katerina Dimakou and Roberta Petrino and \{van de Garde\}, Ewoudt and Restrepo, \{Marcos I.\} and Aruj, \{Patricia Karina\} and Silvia Attorri and Enrique Barimboim and Caeiro, \{Juan Pablo\} and Garz{\'o}n, \{Mar{\'i}a I.\} and Cambursano, \{Victor Hugo\} and \{Adrian Ceccato\}, \{V. H.Dr Cazaux A.\} and Julio Chertcoff and Florencia Lascar and \{Di Tulio\}, Fernando and D{\'i}az, \{Ariel Cordon\} and \{de Vedia\}, Lautaro and Ganaha, \{Maria Cristina\} and Sandra Lambert and Gustavo Lopardo and Luna, \{Carlos M.\} and Malberti, \{Alessio Gerardo\} and Nora Morcillo and Silvina Tartara and Claudia Pensotti and Betiana Pereyra and Scapellato, \{Pablo Gustavo\} and Stagnaro, \{Juan Pablo\} and Sonali Shah and Felix L{\"o}tsch and Florian Thalhammer and Kurt Anseeuw and Francois, \{Camille A.\} and \{Van Braeckel\}, Eva and Vincent, \{Jean Louis\} and Djimon, \{Marcel Zannou\} and Jules Bashi and Roger Dodo and Nou{\'e}r, \{Simone Aranha\} and Jan Rupp",

note = "Publisher Copyright: {\textcopyright} 2020 American College of Chest Physicians",

year = "2021",

month = jan,

doi = "10.1016/j.chest.2020.06.079",

language = "English",

volume = "159",

pages = "58--72",

journal = "Chest",

issn = "0012-3692",

publisher = "Elsevier Inc.",

number = "1",

}

TY - JOUR

T1 - Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

AU - GLIMP Investigators

AU - Marin-Corral, Judith

AU - Pascual-Guardia, Sergi

AU - Amati, Francesco

AU - Aliberti, Stefano

AU - Masclans, Joan R.

AU - Soni, Nilam

AU - Rodriguez, Alejandro

AU - Sibila, Oriol

AU - Sanz, Francisco

AU - Sotgiu, Giovanni

AU - Anzueto, Antonio

AU - Dimakou, Katerina

AU - Petrino, Roberta

AU - van de Garde, Ewoudt

AU - Restrepo, Marcos I.

AU - Aruj, Patricia Karina

AU - Attorri, Silvia

AU - Barimboim, Enrique

AU - Caeiro, Juan Pablo

AU - Garzón, María I.

AU - Cambursano, Victor Hugo

AU - Adrian Ceccato, V. H.Dr Cazaux A.

AU - Chertcoff, Julio

AU - Lascar, Florencia

AU - Di Tulio, Fernando

AU - Díaz, Ariel Cordon

AU - de Vedia, Lautaro

AU - Ganaha, Maria Cristina

AU - Lambert, Sandra

AU - Lopardo, Gustavo

AU - Luna, Carlos M.

AU - Malberti, Alessio Gerardo

AU - Morcillo, Nora

AU - Tartara, Silvina

AU - Pensotti, Claudia

AU - Pereyra, Betiana

AU - Scapellato, Pablo Gustavo

AU - Stagnaro, Juan Pablo

AU - Shah, Sonali

AU - Lötsch, Felix

AU - Thalhammer, Florian

AU - Anseeuw, Kurt

AU - Francois, Camille A.

AU - Van Braeckel, Eva

AU - Vincent, Jean Louis

AU - Djimon, Marcel Zannou

AU - Bashi, Jules

AU - Dodo, Roger

AU - Nouér, Simone Aranha

AU - Rupp, Jan

PY - 2021/1

Y1 - 2021/1

N2 - Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P <.001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

AB - Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P =.021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P <.001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

UR - https://www.scopus.com/pages/publications/85098083139

U2 - 10.1016/j.chest.2020.06.079

DO - 10.1016/j.chest.2020.06.079

M3 - Journal articles

C2 - 32687909

AN - SCOPUS:85098083139

SN - 0012-3692

VL - 159

SP - 58

EP - 72

JO - Chest

JF - Chest

IS - 1

ER -

Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

Abstract

Funding

UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

Access to Document

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